The British government budgeted close to $12 billion to transform its health-care system with information technology. The result: possibly the biggest and most complex technology project in the world and one that critics, including two Members of Parliame

Bold Vision

Specifically, the systems and information-technology services the NHS is attempting to deliver include the NHS Care Records Service (NHS CRS)individual electronic NHS lifelong care records for every patient in England (Scotland, Northern Ireland and Wales are not part of the system), securely accessible by the patients and those caring for them. This is also known as the National Spine. Electronic transmission of prescriptions is also in the offing.

Other pieces of the project, already partially functional, are Choose and Book, which provides patients of hospitals or clinics with convenience in selecting the date and time of their appointments; and N3, which provides information-technology infrastructure and broadband connectivity for the NHS so patient information can be shared among organizations.

To supervise the NPfIT, the NHS created a unit, Connecting for Health, to deliver "new, integrated I.T. systems and services to help modernize the NHS and ensure care is centered around the patient," according to the agency's Web site.

If the CfH succeeds, the benefits could be enormous. "This is very much a pioneering effort," notes Gartner European health-care analyst Jonathan Edwards. "No country has ever implemented anything on this scale. If successful, it could be of great value to health-care providers around the world. It's important to understand the program and learn from its successes and challenges."

"It is the boldest vision that any government has ever taken with respect to I.T.and it comes against a background of high-profile failures in big government computer projects," adds Sean Brennan, author of The NHS IT Project: The Biggest Computer Program in the World Ever!

David Craig (a management consultant writing under a pseudonym) and Richard Brooks, co-authors of Plundering the Public Sector, have reported on some of those failures, among them part of an e-government initiative in 2000. At the time, Customs and Excise launched a program to provide e-services. By June 2004, the department had spent close to $200 million on its e-VAT (value added tax) service. According to the U.K. Parliament's Public Accounts Committee, the project proved a failure because the new system was more complicated than the previous paper-based version.

And what if the NPfIT project fails? "If it goes wrong, with the all too depressingly familiar sight of budgets and time scales spiraling hopelessly out of control, our government will have caused the largest hemorrhage of taxpayers' money from essential [medical] services into the pockets of management and I.T. consultants in British history," Craig and Brooks wrote in Plundering the Public Sector.